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Primary Care Strategic Delivery Plan

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Primary Care Strategic Delivery Plan DRAFT – work in progress Cambridgeshire and Peterborough Primary Care Strategic Delivery Plan DRAFT V9 June 2019 DRAFT – work in progress Executive Summary The CCG published its General Practice Forward View Strategy in 2017. This set out the local ambitions for supporting the sustainability and transformation of General Practice. The Primary Care Strategic Delivery Plan is the refresh in light of local system plans and in the context of national contractual changes and policy direction. In January 2019, NHS England published The NHS General Practice Delivered at Scale Long Term Plan (LTP) set out the overarching long- 21 Primary Care Networks have been established term goals for the NHS and specific changes for across Cambridgeshire and Peterborough. Primary Care. To support delivery of the Primary Community, voluntary and local authority services will Care elements, amendments were needed to the now start to wrap around the same geography to national GP Contract and these were published in the form of Investment and evolution: A five-year develop a placed based approach to the health, care framework for GP contract reform to implement The and wellbeing of the local population. NHS Long Term Plan. Cohesive Online and Extended Access Sustainability and Transformation Partnerships Improved access to Primary Care in terms of (STPs) have been asked to include a revised consultation modality. Primary Care Strategy, setting out how they will Workforce and workload optimisation ensure the sustainability and transformation of Primary Care and general practice to improve Effective retention of Primary Care workforce resulting population health covering 2019/20 to 2023/24. in reduced rate of attrition and build of resilience. As an STP that is coterminous with a single CCG, Digital and estate future-proofing Cambridgeshire and Peterborough CCG has Digital solutions to underpin integrated service delivery developed the Primary Care Strategic Delivery Plan and aligned to Primary Care, with ambition of on behalf of the STP and will work in partnership achieving an Integrated Care Record. with the North and South Alliances to support its Improve quality of Primary Care estate that supports implementation. The STP and Alliances vision for frontline service delivery for patients, in the context of Integrated Neighbourhoods will be in Autumn 2019, Integrated Neighbourhoods. by agreement with NHSE/I. 2 DRAFT – work in progress Our population Within Cambridgeshire and Peterborough, NHS partners, Primary Care and local government have come together to improve the quality of health and care of our local population and to return the STP system back to financial sustainability. Overall, Cambridgeshire and Peterborough is a healthy place to live and one that compares generally well with national health and North population: wellbeing determinants and outcomes. However, there are areas 565,000 within Cambridgeshire and Peterborough with more widespread health and wellbeing issues where health determinants and outcomes are often more adverse than in Cambridgeshire and Peterborough and often similar to, or worse than, national averages, e.g. in Fenland. There are also some very small areas, often with relatively high levels of disadvantage and deprivation, which have correspondingly adverse health and wellbeing determinants and outcomes. In some areas of Cambridge City in particular further attention may be needed to reduce health inequalities and to reverse emerging adverse trends in some health determinants and outcomes. While the economy of Cambridge City is booming, the health of people in Peterborough is varied compared with the England average. Peterborough is one of the 20% most deprived districts/unitary authorities in England and about 23% (10,400) of children live in low South population: income families. Life expectancy for both men and women is lower 415,000 than the England average. Life expectancy is 8.4 years lower for men and 6.1 years lower for women in the most deprived areas of Peterborough than in the least deprived areas. 3 DRAFT – work in progress We expect continued growth but forecasts from different sources vary Cambridgeshire and Peterborough - absolute long term (20 year) population change, 2016 to 2036 (all ages) Source: ONS 2016-based Subnational population projections and CCCRG mid-2015 based population forecasts (JSNA CDS figure 8) 4 DRAFT – work in progress The CCG’s GP registered population is also growing Cambridgeshire and Peterborough CCG registered population, 2011-2018* NOTE: axis does not start at 0 *Data from April each year. Data for the period 2011 and 2012 (prior to the start of the CCG) are estimated. Source: Serco and NHS Digital (JSNA CDS figure 5) 5 DRAFT – work in progress Challenges for Primary Care Primary Care in Cambridgeshire and Peterborough has significant challenges to meet the needs of both the patients and the workforce. Our system faces increasing demand for local illnesses need and want integrated, proactive care services. We are one of the fastest growing to keep them healthy and well at home. They value areas of the country, with an ethnically diverse continuity of care with their Primary Care team. population. The Cambridgeshire and Peterborough registered population is growing by Our current workforce is ageing, and we are 1.95% year on year (Compound Annual Growth struggling to recruit and replace Primary Care staff Rate). Increasingly complex care pathways are not in many areas. We need to enable general practice consistent or readily adaptable, Primary Care to be a more attractive place for people to work and services are currently ill-equipped to manage to create the employment opportunities for new complex elderly and multi-morbid patients. Several roles across the skill mix. practices are being identified as requiring support to improve resilience. We need to Operational and workforce pressures are resulting change the way Primary Care operates, to better in an increasing number of financially manage the demand and complexity coming challenged practices, including some where the through the doors. salaried GPs are earning more than the practice partners. Alongside the unique position the system Our elderly population is growing rapidly, finds itself in regard to the national Carr-Hil funding increasing the number of people with long-term formula and the global sum allocation to practices. conditions, with 51% more over 75s expected by 2026. Previously unaddressed needs such as Demand on services is even higher due to high mental health problems are being recognised, with patient expectations. Patients want a seamless a requirement to meet them. We need to improve service experience across health and care the ways we address issues of prevention in organisations. Services may be co-located in the Primary Care, working with our public health and same buildings, but not integrated with each other. social care colleagues. Patients with long term We need to work better with our partners in 6 community, social, voluntary and secondary care. DRAFT – work in progress Redeveloping our Primary Care strategy Cambridgeshire and Peterborough’s Primary Care Strategic Delivery Plan is being refreshed to meet our challenges and is be shaped around the STP ambition for Integrated Neighbourhoods, the CCG’s priority area of GP Services Delivered at Scale and will build on the ambitions set out in its current GPFV strategy. The CCG published its General Practice Forward The cornerstone of each Integrated Neighbourhood View Strategy in 2017. This set out the local is a PCN. Cambridgeshire and Peterborough’s ambitions for supporting the sustainability and population of almost one million patients will be transformation of General Practice . It is timely to covered by 21 PCNs. refresh this strategy in light of local system plans, a growing population and in the context of national The CCG’s Operating Plan sets out six “Big Ticket” contractual changes and policy direction. focus areas for 2019-2021. The CCG has identified GP Services Delivered at Scale as one of these The Cambridgeshire and Peterborough STP plan to areas of focus. This will ensure commissioning of improve the health and care of our local population services is aligned to the emerging PCNs to ensure and bring the system back into financial balance better sensitivity to population need and to support was published in October 2016. The STP are the development and purpose of Primary Care at adopting one approach for the improvement of all scale. Ensuring that improving quality and patient public services by focusing on place based experience is at the heart of this. improvement and locally tailored services to meet the local population need. Strategic delivery will be underpinned by the requirements and timeframes set out in the recently There are three areas of focus under this combined published Investment and evolution: A five-year programme of work to help support developments framework for GP contract reform to implement The within the different areas of health, social care and NHS Long Term Plan and Health and Social Care wider public services; Primary Care Networks, regulations. Think Communities and Integrated Neighbourhoods. 7 DRAFT – work in progress Place-based approach There are three areas of focus of place based improvement to support developments within the different areas of health, social care and wider public services. Place Based Approach • A collaborative approach to improving the health, wellbeing and quality of life
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